Financial Clearance Specialist II - Rev Cycle

UTHealth Houston•Houston, TX

2d•Remote

About The Position

The RCM Financial Clearance Specialist II is responsible for verifying insurance benefits and obtaining required authorizations and referrals to ensure financial clearance before patient services. This position supports new and established patients by ensuring accurate registration, eligibility, and authorization of services through effective communication with payers, providers, and patients. The Specialist also creates cost estimates and educates patients on financial responsibilities while maintaining compliance with internal policies and external regulations. Join UTHealth Houston's Revenue Cycle team as an RCM Financial Clearance Specialist II. In this senior-level role, you will lead complex insurance verification and authorization activities, ensure accurate financial clearance, resolve payer issues, and support patients through the healthcare journey. You'll also serve as a mentor to team members while maintaining excellence in Epic documentation, compliance, and customer service.

Requirements

3+ years of insurance authorization, verification, or healthcare financial clearance experience
Experience resolving complex insurance cases
High School Diploma or equivalent required
3 years experience in healthcare financial clearance, insurance verification, or a related revenue cycle role required
Employees must permanently reside and work in the State of Texas.

Nice To Haves

Epic experience preferred
Associate degree preferred
Associate's Degree in healthcare or business-related field preferred

Responsibilities

Analyze benefit information and clinical documentation to ensure appropriate coverage and medical necessity per payer guidelines.
Perform all registration components from charge review to ensure accurate patient registration and compliance with payer requirements before claim submission.
Obtain prior authorizations for services per insurance policies and initiate Peer-to-Peer (P2P) reviews as needed.
Collaborate with clinical, scheduling, and financial teams for financial clearance.
Communicate benefits and cost estimates with patients.
Identify and update referral authorization numbers when applicable.
Accurately input and maintain insurance data in Epic based on real-time eligibility response or payor portals; ensure insurance plan selection aligns with the UT Managed Care Payer Plan Tool.
Identify and report trends in denials, payer issues, or workflow inefficiencies to support continuous improvement and leadership decision-making.
Maintain compliance with HOOP policies, HIPAA, and payer guidelines.
Performs other duties as assigned.